PHEMPHIGUS VULGARIS EVOLVING INTO PEMPHIGUS VEGETANS

Abstract

A 76-year-old male presented with multiple painful bullae and erosive lesions scattered through the abdomen and back, and erosive lesions on oral mucosa. Histology and perilesional direct immunofluorescence following cutaneous biopsy led to the diagnosis of pemphigus vulgaris. The patient was submitted to treatment with oral corticosteroid and azathioprine with gradual improvement. After progressive dose reduction, corticotherapy was suspended, keeping treatment with azathioprine alone. After three months clinical deterioration was noticed and new vegetative cutaneous lesions arose in intertriginous areas and, to a smaller extent, in the oral cavity. Histopathologic examination supported the diagnosis of pemphigus vegetans and clinical remission was achieved following re-introduction of oral corticosteroid in association with azathioprine.